Signature Program Application step 2 - Jen Mac's Something Different for Women

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Jen Mac’s group & 1 on 1 programs provide excellent, secondary support to all enrolled! This means there’s support during each actual class or session via Jen's teachings, her in class or in session exercises, her homework assignments & the community you’re able to connect with here! Because we’re a community of hundreds though, it’s not physically possible for Jen to give additional private time outside of classes or sessions. Therefore, we require all participants have a primary support system already in place so you're always fully supported! This means you have any or all of the following: supportive parents(s), supportive sibling(s), supportive spouse or partner, supportive friend(s), supportive colleague(s), supportive therapist, support group, supportive clergyman/woman, supportive spiritual/religious community of some kind.(Required)

Yes, I have a primary support system in place and would like to continue.

Full Legal Name:(Required)

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Email(Required)

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Date

MM slash DD slash YYYY

Mobile Phone(Required)

Please Provide Either Home or Work As a Second Contact Number

Location(Required)

City / Town State / Province / Region Country

1. (Check off any or all that apply to you) I am a(Required)

leader

aspiring leader

doer

learner

If you are a leader, please check all that apply:(Required)

for my own company

for a company/organization

for a team/staff of people

for my immediate family

for my extended family

for my household

for my partner

for my child/children

for an additional organization I run and/or sit on the board for

for an additional organization I volunteer for

for my community

If you are an aspiring leader, please check all that apply:(Required)

for a business I’m starting/would like to start

for a position I’d like to move up or into at work that includes leadership responsibilities

for myself; to be better to myself in all areas of my life

for my immediate family

for my extended family

for a child I plan to have soon

for a child I plan to have someday soon

for an organization I volunteer for

for my community

2. At this juncture of your life, what specifically are you looking to either improve, positively change or create next for yourself, personally and/or professionally? How are you hoping my program will support you with this? Please explain.(Required)

3. What are 3 adjectives you would use to describe yourself?

Adjective 1(Required)

Adjective 2(Required)

Adjective 3(Required)

What are 3 adjectives someone who knows you really well would use to describe you?

Adjective 1(Required)

Adjective 2(Required)

Adjective 3(Required)

What are 3 adjectives you think someone who just met you would use to describe you?

Adjective 1(Required)

Adjective 2(Required)

Adjective 3(Required)

4. The following qualities identify me (please check all that apply):(Required)

kind

positive

hard working

solution oriented

helpful

humble

efficient

friendly

approachable

studious

focused

responsible

reliable

persistent

results oriented

5. Please share 1-3 of your greatest accomplishments to date…& why you feel they’re your greatest accomplishments so far.(Required)

6. Which best describes you?(Required)

I’d positively contribute to any group & while my life’s presently great, I can always learn more to further develop myself... so sign me up please!

I’d positively contribute to any group & while my life’s presently good, there are definitely areas that can use improvement... so sign me up please!

My life’s presently not so great yet I know developing myself further will benefit me & that I’d still be a positive contributor to any group... so sign me up please!

My life’s presently not so great yet I need something still I’m not sure I’d positively contribute to a group right now so signing up another time’s probably best.

7. Who personally referred you to us? If you were not personally referred, how did you hear about us?(Required)